IRLF 


SB    272 


Fire  Prevention  and 
Fire  Protection 

f°T. 
Hospitals 

By  OTTO  R.  EICHEL,  M.  D 


A  MANUAL 


OF 


FIRE   PREVENTION 

AND 

FIRE   PROTECTION 


FOR 


HOSPITALS 


BY 

OTTO  R.  EICHEL,  M.D. 

Director,  Division  of  Sanitary  Supervisors 
New  York  State  Department  of  Health 


NEW  YORK 
JOHN  WILEY  &  SONS,  INC. 

LONDON  :    CHAPMAN  &  HALL,   LIMITED 
1916 


/ 

^ 


Copyright,  1916,  by 
OTTO   R.  EICHEL 


PUBLISHERS  PRINTING  COMPANY 
207-217  West  Twenty-fifth  Street,  New  York 


PREFACE 

IT  is  the  purpose  of  this  manual  to  pro- 
vide in  convenient  form  an  outline  of  the 
principles  of  fire  prevention  and  protection 
with  indications  for  their  application  in 
institutions  housing  the  sick.  It  is  planned 
for  use  not  only  by  superintendents  and 
boards  of  managers,  but  also  by  inspectors, 
architects,  builders,  and  others  who  have 
occasion  to  consider  the  fire  problem  hi 
hospitals. 

As  has  been  pointed  out  by  high  authority, 
the  extent  to  which  the  subject  generally  is 
neglected  by  many  institutions  is  hardly  less 
than  criminal.  Indeed,  in  many  hospitals 
only  a  merciful  Providence  seems  to  pre- 
vent unspeakable  disasters.  The  author's 

personal    observation    and    study    of    this 
iii 


359272 


IV  PREFACE 

condition  have  resulted  in  the  preparation 
of  this  manual,  which,  it  is  hoped,  will  meet 
a  real  need. 

The  author  is  much  indebted  to  Dr. 
Hermann  M.  Biggs,  New  York  State  Com- 
missioner of  Health,  for  permission  to  pub- 
lish this  work;  to  his  Deputy,  Dr.  Linsly 
R.  Williams,  for  the  suggestion  to  prepare 
it;  to  Mr.  Franklin  H.  Wentworth,  Secretary 
of  the  National  Fire  Protection  Association, 
for  valuable  suggestions,  and  to  Dr.  Willard 
J.  Denno,  Secretary  of  the  New  York  State 
Board  of  Medical  Examiners,  for  criticism 
of  the  manuscript. 

OTTO  R.  EICHEL,  M.D. 
Albany,  N.  Y., 
April,  1916. 


CONTENTS 

PAGE 

PREFACE iii 

PART  A. — INTRODUCTORY       i 

I.     Definitions  and  Abbreviation         ....  i 

II.     General  Considerations 5 

III.     Recommendations       10 

PART  B. — COMMON    HAZARDS    IN    HOSPITALS    AND 

THEIR  SAFE-GUARDING 15 

I.     Lighting  Hazards 15 

II.     Heating  Hazards 20 

III.  Exposure  Hazards       . 25 

IV.  Miscellaneous  Hazards 28 

PART  C. — FIRE  APPLIANCES  AND  SAFEGUARDS     .    .  33 

I.     Chemical  Extinguishers        33 

II.     Other  Hand  Extinguishers 37 

III.     Other  Appliances 43 

PART  D. — MISCELLANEOUS  PRECAUTIONS    ....  51 

PART  E. — HOSPITAL  FIRE  DEPARTMENT      ....  55 


HOSPITAL    FIRE    MANUAL 

PART  A— INTRODUCTORY 

I 

DEFINITIONS  AND  ABBREVIATIONS 

For  the  purpose  of  this  book  the  following 
abbreviations  are  used: 

N.  B.  F.  U.— The  National  Board  of  Fire 
Underwriters  is  an  association  of  practically 
all  the  fire  insurance  companies  in  the 
United  States.  Through  its  committees  it 
promotes  legislation,  suppresses  arson,  col- 
lects statistics,  and  makes  scientific  studies 
of  fire  origins  and  means  of  prevention  and 
protection.  Has  branch  offices  in  many 
cities.  Main  office,  76  William  Street,  New 
York  City. 


2  •>  SOSPITAL  FIRE  MANUAL 

N.  F.  P.  A.— The  National  Fire  Protec- 
tion Association  includes  nearly  all  the 
associations,  companies,  bureaus,  and  in- 
stitutions interested  in  fire  prevention  and 
fire  protection  in  the  United  States  and 
Canada.  It  has  a  world-wide  subscribing 
membership.  It  promotes  fire  prevention 
and  protection  in  every  possible  way.  Its 
work  is  broader  in  scope  than  that  of  the 
N.  B.  F.  U.,  which  is  one  of  its  members. 
It  prepares  many  valuable  publications  on 
fire  matters,  one  of  the  most  useful  being 
its  "  Field  Practice."  It  does  educational 
work  and  establishes  standard  rules,  re- 
quirements, and  specifications  regarding 
hazards  and  their  safeguarding,  fire  equip- 
ment, etc.  Its  standards  are  adopted  by 
the  N.  B.  F.  U.  and  its  laboratories,  and 
are  universally  recognized  as  authoritative. 
Address,  87  Milk  Street,  Boston,  Mass. 


HOSPITAL  FIRE   MANUAL  3 

U.  Lab. — The  Underwriters'  Laboratories, 
Inc.,  are  under  direction  of  N.  B.  F.  U. 
They  make  examinations  and  tests  of  fire 
devices,  materials,  and  apparatus  under 
standards  recommended  by  the  N.  F.  P.  A., 
and  publish  a  list  of  manufacturers  of 
such  appliances,  which  is  revised  semi- 
annually. 

National  Electrical  Code. — This  code  con- 
tains recommendations  for  reducing  the 
hazards  of  electricity.  It  is  promulgated  by 
the  N.  B.  F.  U.  from  recommendations 
made  by  the  N.  F.  P.  Association's 
Electrical  Committee,  formerly  known  as 
the  Underwriters'  National  Electric  Asso- 
ciation. The  code  is  generally  accepted  as 
standard. 

Fire  Hazard. — A  condition  which  may 
cause  fire. 

Fire  Prevention. — Concerns  fire  hazards, 


4  HOSPITAL  FIRE  MANUAL 

educational  and  private  administrative  mea- 
sures, and  legislation. 

lire  Protection. — Concerns  control  by 
means  of  construction  features,  fire  appli- 
ances, and  safeguards  against  hazards. 


II 

GENERAL  CONSIDERATION 

Prevention  and  Protection. — It  is  a  not- 
able fact  that  hospitals  often  approach  the 
fire  problem  from  the  view-point  of  protec- 
tion rather  than  prevention;  and  occasionally 
with  regard  chiefly  to  protection  of  property 
instead  of  human  lives.  This  is  unfortu- 
nate, as  it  results  in  the  neglect  of  attention 
to  those  common  hazards  which  cause  the 
majority  of  fires,  and  the  installation,  in- 
stead, of  expensive  appliances,  the  proper 
use  of  which  may  be  neither  practised  nor 
understood.  It  is  of  primary  importance 
to  detect  and  safeguard  the  simple  hazards, 
and  to  provide  adequate  protection  for 

lives  first. 

5 


6  HOSPITAL  FIRE  MANUAL 

Hospital  Fires. — Although  in  the  past  the 
loss  of  life  in  hospital  fires  has  been  com- 
paratively small,  the  aggregate  loss  in 
property  has  been  large.  Fires  in  hospitals 
are  by  no  means  so  infrequent  as  one  might 
suppose.  While  making  a  survey  of  certain 
tuberculosis  hospitals  in  New  York  State, 
the  author  found  that  during  a  brief  period 
of  time  they  had  suffered  from  a  number  of 
incipient  fires:  two  from  electric  flat-irons, 
three  from  gas  appliances,  two  from  defec- 
tive flues,  two  from  kitchen  ranges,  four  from 
adjoining  woodlands,  two  from  incinerators, 
and  in  two  more  instances  large  frame 
buildings  were  entirely  destroyed.  Such 
accidents  are  not  rare  in  hospitals  generally. 
The  publicity  given  these  incidents  was  very 
limited,  probably  because  no  lives  were  lost. 
However,  it  should  not  remain  for  a  hospital 
holocaust  corresponding  with  the  Iroquois 


HOSPITAL  FIRE  MANUAL  7 

Theatre  fire  to  awaken  hospital  authorities 
to  the  gravity  of  the  fire  risk  in  which,  only 
too  often,  they  house  the  bed-ridden  sick. 
The  hospital  is  virtually  a  large  residence. 
Fires  of  the  residence  class,  of  both  known 
and  "unknown  origin,"  are  usually  due  to 
such  common  and  easily  preventable  causes 
as  electrical  or  gas  hazards,  or  defective 
flues  and  chimneys. 

The  Cost  of  Fires. — The  importance  of  the 
matter  may  be  further  emphasized  by  view- 
ing it  in  the  light  of  the  problem  generally. 
Experience  has  shown  the  danger  to  life  to 
be  greater  in  buildings  where  people  live 
than  in  those  where  they  work  or  play.  It 
is  believed  probable  that  more  lives  are  lost 
in  residence  fires  than  in  factories,  theatres, 
and  schools  combined.  The  popular  mind 
entertains  the  obverse  conception  of  the 
facts,  probably  because  only  the  fire  which 


8  HOSPITAL  FIRE  MANUAL 

destroys  many  lives  receives  wide  publicity. 
Fire  causes  an  average  annual  property  loss 
in  the  United  States  of  $250,000,000 — 
$30,000  per  hour,  or  $500  per  minute;  an 
annual  per  capita  fire  tax  of  $2.50.  This 
enormous  loss  is  especially  deplorable  as 
most  fires  are  readily  preventable.  Eco- 
nomic conditions  are  necessarily  affected  by 
such  large  losses.  They  must  be  met  by 
the  insurance  companies  from  their  collec- 
tions, which  are  practically  an  assessment 
on  all  the  people. 

The  Fundamental  Evil. — It  is  not  only  of 
primary  importance  to  prevent  fires  by 
safeguarding  the  common  hazards,  but  also 
by  obviating  such  fundamental  causes  as 
the  carelessness,  indifference,  and  negligence 
of  the  average  citizen.  It  has  long  been 
recognized  by  fire  experts  that  to  these  are 
due  the  much  greater  prevalence  of  fires  in 


HOSPITAL  FIRE  MANUAL  9 

this  country  than  in  Europe.  This  can  be 
accomplished  in  a  democratic  state  only  by 
education,  and  to  some  extent  by  enforced 
legislation. 


Ill 

RECOMMENDATIONS 

Below  are  enumerated  certain  general 
recommendations  for  all  hospitals.  These 
are  an  application  to  the  conditions  found 
in  hospitals,  of  well-established  facts  and 
principles  regarding  fire  prevention  and  fire 
protection: 

1.  That  there  be  strict  compliance  with 
existing  local  or  state  laws  regulating  fire- 
hazards,  e.g.,  regarding  explosives,  matches, 
motion-picture    machines,    building    codes, 
fireworks,  chimneys  and  flues,  inflammable 
liquids,  etc. 

2.  Cooperation  and  consultation  with  the 
local  fire  department  within  whose  district 

the  hospital  may  be  located. 
10 


HOSPITAL  FIRE  MANUAL  11 

3.  Consultation   with    the   Fire    Under- 
writers and  compliance  with  their  sugges- 
tions in  every  instance  where  they  have 
jurisdiction. 

In  every  case  where  it  is  possible  without 
conflict  with  results  of  the  foregoing  steps, 
it  is  further  recommended: 

4.  That  hi  every  hospital  where  any  of 
the  fire  hazards  described  hi  Part  B  below 
exist  such  steps  as  are  outlined  be  taken  to 
safeguard  against  them. 

5.  That  each  hospital  have  a  minimum 
fire  apparatus  of  "small  size"  (1^2  gallons) 
or  of  the  "one  quart  size"  chemical  hand 
extinguishers  as  described  on  page  34,  an 
adequate  number  to  be  distributed  on  each 
floor  of  each  building.     That  the  standard 
size   (2^4  gallons)   extinguisher  be  discon- 
tinued   where    patients    and    women    and 
children  may  be  obliged  to  handle  them. 


12  HOSPITAL  FIRE  MANUAL 

The  use  of  chemical  extinguishers  on  wheels 
to  be  optional.  They  are  expensive  but 
valuable  for  isolated  hospitals.  That  fire 
pails  be  used  as  secondary  equipment. 
That  for  garage,  electrical  machinery,  and 
hazardous  fluids  the  one-quart  chemical  hand- 
extinguisher  and  pails  of  sand,  as  described 
on  page  37,  be  used.  That  dry  powder  and 
grenade  type  extinguishers  be  abolished. 

6.  That  appliances  described  on  pages  43 
and  45  (fire-doors,  escapes,  and  ladders)  be 
used  where  the  fire  safety  could  be  greatly 
improved  within  the  limitations  outlined. 

7.  That  appliances  described  on  pages  43 
and  44,  such  as  paints,  hose,  faucets,  and 
alarm  box,  be  adopted  so  far  as  possible. 

8.  That  the  water  supply  be  given  atten- 
tion as  described  on  pages  51-52. 

9.  That  all  the  miscellaneous  precautions 
described  in  Part  D  regarding  valves,  hy- 


HOSPITAL  FIRE  MANUAL  13 

drants,  gravity  and  pressure  tanks,  and  locked 
doors,  be  observed  in  all  hospitals  to  which 
they  may  apply. 

10.  That  private  fire  departments  be  estab- 
lished in  all  hospitals,  with  rules,  organiza- 
tion, drill,  and  inspection  service  based  on 
the  general  outlines  given  in  Part  E  and 
within  such  limitations  as  may  be  necessary. 

11.  That  educational  work  be  done  in  fire 
prevention  and  protection,  as  outlined  on 
page  66,  within  such  limitations  as  may  be 
necessary. 

12.  That  so  far  as  possible  no  fire  devices, 
materials,  apparatus,  or  other  appliances  be 
purchased  except  such  as  are  approved  in 
the  latest  list  issued  by  the  U.  Laborato- 
ries, and  that  other  safeguards  and  means 
of    protection   comply   with   the   standard 
rules,   requirements,   and    specifications   of 
the  N.  F.  P.  A. 


PART    B  —  COMMON    HAZARDS    IN 

HOSPITALS   AND    THEIR 

SAFEGUARDING 

I 
LIGHTING  HAZARDS 

1.  Candles. — The  use  of  candles  presents 
a  constant  danger,  as  they  are  very  com- 
bustible, easily  dropped  or  tipped  over,  can 
fall  into   small   openings,   present   an  un- 
guarded flame,  may  continue  to  burn  after 
being  dropped,  and  the  wick  may  glow  after 
flame  is  extinguished.     There  is  practically 
no  instance  in  which  they  could  not  be 
abolished.     The  small  electric  hand  torch  is 
much  safer  and  should  be  used  instead. 

2.  Gas  Jets. — These  present  a  constant 
fire  hazard  if  located  very  near  to  walls, 

15 


16  HOSPITAL  FIRE  MANUAL 

ceilings,  shelves,  attic  roofs  or  rafters;  or 
where  open  doors  may  come  in  contact. 
Where  inflammable  material  may  touch  the 
jets,  as  in  storerooms  and  closets,  the  jets 
should  be  entirely  removed  or,  in  some 
cases,  lengthened  and  the  lights  protected 
by  wire  bonnets.  Movable  jets  should  not 
be  used. 

3.  Gas  Lamps. — They  should  have  broad 
bases  and  no  inflammable  trimmings,  and 
only    non-inflammable    connections.     They 
should  not  be  used  if  electric  lights  are 
available.     All  gas  hose  of  flexible  tubing 
contains  rubber,  and   therefore  will  burn, 
although  some  types  have  metallic  covers. 
Rigid  installations  should  be  secured  wher- 
ever possible. 

4.  Kerosene  Lamps. — The  danger  from 
this  common  cause  of  fires  needs  no  em- 
phasis.   Their  use  should  not  be  permitted, 


HOSPITAL  FIRE  MANUAL  17 

but  if  essential  they  should  be  of  metal 
and  of  broad  base  design,  or  of  non-cap- 
sizable  construction. 

5.  Lanterns. — These  present  the  same 
conditions,  and  the  same  general  precau- 
tions should  be  observed  as  in  the  case  of 
kerosene  lamps.  If  they  are  essential,  only 
good  safety  lanterns,  should  be  used — of  the 
type  used  by  watchmen  and  railroad  em- 
ployees (broad  base  and  protected  with  wire 
fenders).  The  lantern  having  a  removable 
bottom  for  oil  should  not  be  used — such  bot- 
toms may  become  loose  and  drop  out. 

The  electric  hand  torch  is  to  be  preferred 
wherever  possible. 

N.  B. — If  much  kerosene  is  needed,  as 
for  lamps,  lanterns,  heaters,  stoves,  etc., 
only  high  test  oil  should  be  used,  as  required 
by  the  U.  S.  A.  specifications,  or  as  used 
by  the  railroad  companies.  Such  kerosene 


18  HOSPITAL  FIRE   MANUAL 

is  said  to  be  superior  also  in  other  respects 
to  the  ordinary  kind. 

6.  Alcohol  Lamps. — Their  use  can  usually 
be  limited  to  the  laboratory,  and  even  there 
they  should  be  abolished,  if  possible,  and 
stationary  gas  flame  used  instead.     Benzine 
and  gasoline  should  be  kept  away,  especially 
if  kept  in  bottles  which  may  be  mistaken 
for  alcohol  bottles. 

7.  Electric  Lamps. — Especially  if  old,  in- 
candescent lamps  become  very  hot,  and  will 
char  paper  or  cloth  if  in  contact  with  them, 
and  have  even  been  known  to  ignite  wood. 
Usually  paper  and  cloth  shades  should  not 
be  used  on  electric  lamps. 

Incandescent  lamps  should  be  stationary, 
wherever  possible,  and  not  in  contact  with 
combustible  material;  movable  lamps  should 
be  equipped  with  wire-bonnets  or  similar 
protective  device;  cords  should  not  be  hung 


HOSPITAL  FIRE   MANUAL  19 

over  non-insulated  places,  as  pipes,  nails, 
hooks,  etc.,  and  should  not  have  knots  tied 
in  them. 

Electric  lighting  systems,  their  use  and 
changes  and  extensions  in  them,  should  be 
in  accordance  with  the  requirements  of  the 
National  Electrical  Code.  Injuries  to  the 
system,  or  its  disturbance  by  storms,  etc., 
should  usually  be  corrected  by  expert 
electricians. 

8.  Acetylene  Systems. — The  hazards  of 
these  systems  may  be  safeguarded  by  ob- 
serving the  "  Standard  Rules  and  Require- 
ments" of  the  N.  F.  P.  A. 


II 

HEATING  HAZARDS 

1.  Fireplaces. — The     chief      precautions 
necessary  are  proper  construction,  to  have 
the   flooring   about   the   fireplace   of   non- 
combustible  material,  and  to  protect  against 
flying  sparks  or  rolling  logs  by  good  and- 
irons and  screens.     The  latter  to  be  of  such 
size  and  design  as  to  completely  cover  the 
front  of  the  fireplace  and  not  tip  over  easily. 
The  one-piece  screen  with    curved  top  is 
usually  to  be  preferred.     (See  N.  F.  P.  A. 
suggested  Municipal  Ordinances). 

2.  Stoves. — (a)  Coal — There  is  but  slight 
danger  from  coal  stoves  if  properly  installed 
and  cared  for.     They  should  be  erected  on 
metal  legs;    stand  on  zinc,  sheet  iron,  or 

asbestos  base;    and  be  placed  at  a  safe 
20 


HOSPITAL  FIRE  MANUAL  21 

distance  from  walls  or  inflammable  matter 
unless  latter  are  protected.  Ash  receptacles 
of  metal  only. 

(V)  Gas. — Gas  stoves,  ranges,  plates,  burn- 
ers, and  water  heaters  should  be  connected 
with  the  gas  supply  line  by  rigid  iron  piping; 
the  soft  rubber  and  other  inflammable  con- 
nections are  among  the  most  dangerous 
common  fire  causes,  and  should  positively 
not  be  used.  Practically  all  flexible  gas 
hose  contains  rubber  and  will  burn,  although 
some  types  have  metallic  covers. 

These  gas  appliances,  as  well  as  coal 
stoves,  should  be  properly  mounted  on  zinc 
or  asbestos,  and  be  safely  clear  from  walls 
and  combustible  matter,  unless  the  latter 
are  protected  by  metal  or  asbestos. 

(c)  Electric. — Electric  stoves,  heaters,  and 
plates  are  comparatively  safe  and  much  to 
be  preferred  to  coal,  gas,  oil,  and  alcohol 


22  HOSPITAL  FIRE  MANUAL 

appliances.  There  is  danger  in  their  use, 
however,  if  circuits  are  overloaded  or  if 
near  combustible  matter,  and  general  wire 
dangers  are  always  present  where  any  electric 
current  is  used.  These  hazards  are  reduced 
to  a  negligible  minimum  by  proper  installa- 
tion (as  required  by  the  National  Electrical 
Code). 

N.  B. — The  electric  flat-iron  offers  the 
greatest  and  most  prevalent  electrical  hazard 
of  the  day,  and  has  been  the  cause  of  numer- 
ous fires.  These  have  invariably  resulted 
from  carelessness,  as  leaving  the  current  on 
when  not  in  use.  This  may  be  ^avoided  by 
having  a  small  red  pilot  light  on  the  irons 
or  in  the  same  circuit  to  indicate  when  the 
current  is  on.  They  should  never  be  al- 
lowed to  stand  on  inflammable  material 
when  the  current  is  on,  only  well  insulated 
cord  should  be  used,  and  this  should  not  be 


HOSPITAL  FIRE  MANUAL  23 

tied  or  knotted,  and  should  be  kept  clear 
from  hooks,  nails,  piping,  and  other  non- 
insulated  places. 

3.  Furnaces. — The  chief  danger  is  in  over- 
heating.   This  can  be  obviated  by  careful 
attention  to  fires  and  by  proper  construction 
and  installation. 

4.  Stove-Pipes. — If    they    pass    through 
closets,  unused  rooms,  blind  attics,  or  enter 
chimneys  out  of  sight,  present  a  constant 
fire    danger.     Stove-pipes    should    not    be 
passed  through  floors,  roofs,  ceilings,  walls, 
partitions,  or  sides  of  buildings,  unless  pro- 
tected by  metal  ventilated  thimbles  having 
a  6-inch  clearance. 

5.  Steam-Pipes. — These  may  constitute 
a  source  of  danger,  especially  if  improperly 
installed.     Wood  may  spontaneously  ignite 
after  being  charred  by  contact  with  over- 
heated steam-pipes.  This  possibility  has  been 


24  HOSPITAL  FIRE  MANUAL 

proven  by  both  observation  and  labora- 
tory experiment.  Floors  and  walls  should 
be  protected  from  such  pipes  by  metal 
collars;  the  pipes  should  be  insulated  with 
asbestos  or  non-combustible  packing  where 
they  pass  close  to  walls,  ceilings,  or  floors, 
and  in  the  latter  instance  properly  supported 
or  suspended.  Oil  waste,  coal  dust,  and 
other  highly  inflammable  material  should  be 
kept  away  from  steam-piping. 

6.  Chimneys. — If  poorly  constructed, 
cracked,  overheated,  or  used  as  supports  for 
flooring,  timbers,  etc.,  may  be  a  potent  source 
of  fire  danger.  This  is  especially  true  if  an 
ordinary  chimney  is  used  as  a  support,  ow- 
ing to  the  loosening  of  the  chimney  and 
subsequent  ignition  of  the  wood.  This  is  a 
fairly  common  cause  of  fire,  especially  in 
rural  frame  buildings.  (See  the  N.  F.  P.  A. 
suggested  Municipal  Ordinances.) 


Ill 

EXPOSURE  HAZARDS 

A7".  B. — These  exist  where  buildings  are 
adjacent  to  risks,  such  as  other  buildings  or 
forests,  or  in  parts  of  buildings  apt  to  be 
exposed  to  extending  fires,  or  to  adjacent 
risks  connected  by  corridors,  etc.  An  ex- 
tending fire  is  naturally  a  very  serious 
menace  to  the  rest  of  a  building.  (See 
also  paragraph  7  on  page  32.)  Protection 
against  it  may  be  afforded  by  mill  construc- 
tion, wired-glass  windows,  fire  shutters  and 
doors,  and  by  fire-walls  after  the  Porter 
plan,  as  carried  out  in  some  of  the  New 
York  City  Hospitals.  For  instance,  sky- 
lights should  contain  wired  glass,  corri- 
dors may  be  protected  by  fire-doors  or 
shutters,  etc. 

25 


26  HOSPITAL  FIRE  MANUAL 

1.  Forests. — If  near  buildings  they  con- 
stitute an  important  fire  hazard.     If  they 
are  extensive  the  construction  of  a  fire-line 
through  them  at  some  distance  from  the 
buildings  should  be  considered,  as  has  been 
done  at  the  New  York  State  Tuberculosis 
Hospital   at   Raybrook.     Sufficient  spades, 
shovels,  and  axes  should  always  be  available, 
so  that  several  men  may  instantly  attack 
a  forest-  or  brush-fire.     The  one  who  will 
be  responsible  for  the  direction  of  the  fight- 
ing  should   be   familiar   with   the   various 
means  of  controlling  forest-fires.      During 
times  of  drought  special  precautions  should 
be  taken  to  protect  forests  (see  State  and 
United  States  Government  bulletins,  etc.). 

2.  Buildings. — Adjacent   to   other  struc- 
tures constitute  a  danger.     Each  case  will 
require  separate  study.     Where  frame  cor- 
ridors connect  buildings  a  slow-burning  con- 


HOSPITAL  FIRE  MANUAL  27 

struction  of  corridors,  fire-doors,  and  hy- 
drants suitably  located,  may  be  advisable. 

3.  Sparks. —  From    power-house    stacks, 
chimneys  (especially  from  fireplaces),  and 
passing  locomotives  are  dangerous.     Where 
such  conditions  are  possible  wood-shingle 
roofs    should    be    replaced    with    fireproof 
roofing  (see  the  N.  F.  P.  A.  paper  on  "  The 
Evil  Shingle  Roof"). 

4.  Automobiles. —  Obviously      endanger 
buildings  in  which  they  are  housed.     They 
should  not  usually  be  stored  in  barns  and 
never  in  structures  occupied  by  people  or 
live  stock,  or  for  the  storage  of  valuable 
material,  nor  in  the  non-fire-resisting  struc- 
tures which  are  themselves  large  and  ex- 
pensive, or  which  by  their  location  endanger 
near-by  property. 


IV 

MISCELLANEOUS  HAZARDS 

1.  Coal. — If  improperly  stored  may  spon- 
taneously ignite,  and  under  certain  condi- 
tions coal-dust  may   explode.     For  details 
of  preventive  measures,  see  "  Field  Prac- 
tice," of  the  N.  F.  P.  A.,  and  Freitag  on 
"  Fire  Prevention  and  Fire  Protection." 

2.  Chemicals,  Paints,  Oils,  Inflammable 
Volatiles,  and  Explosives. — For  preventive 
measures   see   the   "  Field  Practice"   men- 
tioned above;   and  in  safeguarding  hazards 
from  the  storage,  handling,  and  use  of  such 
materials,  the   "  Standard   Rules   and   Re- 
quirements" of  the  N.  F.  P.  A.  should  be 
carefully  observed.     These  rules  also  cover 
the  details  of  construction  and  installation 
of  Acetylene  Machines,  Gas  and  Gasoline 

28 


HOSPITAL  FERE   MANUAL  29 

Engines,    Valves,    Lighting    Machines,    Oil 
Storage,  etc. 

3.  Smoking.— This    prevalent    cause    of 
fires  needs  hardly  any  emphasis.     Some  fire 
experts   believe   it   to   be   the   commonest 
cause  of  all  fires.     In  certain  places  smok- 
ing or  the  carrying  of  lighted  cigars,  pipes, 
or  cigarettes  should  be  strictly    forbidden 
under  severe  penalty,  and  the  rule  should 
be  rigidly  enforced,  as  in  barns,  paint  shops, 
carpenter  rooms,  storerooms,  garages,  etc. 
As  most  cigarettes  burn  until  they  are  en- 
tirely consumed,   their  use  in    certain   in- 
stances should  be  entirely  prohibited. 

4.  Lightning. — This  is  a  fairly  common 
cause  of  fire,  especially  in  frame  buildings. 
It  seldom  strikes  a  steel  frame  building,  but 
is  said  to  strike  residences  and  rural  frame 
structures  much  oftener  than  is  generally 
believed. 


30  HOSPITAL  FIRE  MANUAL 

Good  rods  of  correct  design,  placed  on  all 
spires  and  projecting  points,  furnish  the  best 
protection. 

Where  cattle  are  enclosed  with  wire 
fences  every  sixth  or  eighth  post  should  be 
grounded  in  an  effective  manner — the  ground 
rod  terminating  with  a  copper  plate  bedded 
in  charcoal. 

Lightning  protection  should  be  in  ac- 
cordance with  the  standard  rules  and  re- 
quirements of  the  N.  F.  P.  A.  During 
electric  storms  and  after  any  building  is 
struck  by  lightning,  there  should  be  a  care- 
ful inspection  to  ascertain  the  existence  or 
possibility  of  fire  from  injured  electric  wires, 
chimneys,  etc. 

5.  Holiday  Celebrations. — Independence 
Day  and  Christmas  Day  celebrations  have 
been  a  prolific  source  of  fires,  owing  to  the 
use  of  fireworks,  inflammable  decorations, 


HOSPITAL  FIRE  MANUAL  31 

defective  temporary  wiring,  candle  illumina- 
tions, etc. 

When  preparing  for  such  celebrations  the 
"  Holiday  Bulletins  "  of  the  N.  F.  P.  A. 
should  be  consulted.  These  are  issued  an- 
nually, preceding  July  4  and  December  25, 
and  contain  valuable  suggestions  for  fire 
prevention  and  protection. 

6.  Ashes,  Rubbish,  Sweepings,  Inflam- 
mable Refuse,  etc. — The  careless  disposal  of 
these  materials  is  a  common  cause  of  fires, 
although  plainly  enough  they  should  be 
kept  away  from  stoves,  fires,  hot  steam- 
pipes,  or  other  places  where  ignition  is  pos- 
sible by  contact,  should  not  be  allowed  to 
accumulate,  and  the  receptacles  used  should 
be  of  metal.  Especially  ashes  and  oil  or 
cotton-waste  always  should  be  disposed  of 
in  metal  cans. 

(See  the  U.  Lab.  list  of  manufactures  of 


32  HOSPITAL  FIRE   MANUAL 

approved  types  of  safety  cans  and  waste 
cans,  tanks,  fire  pails,  etc.) 

7.  Fires. — Fires  themselves,  naturally,  of- 
fer a  great  hazard  because  of  the  possibility 
of  apparently  extinguished  fires  continuing 
to  burn  in  concealed  places  or  to  smoulder 
and  blaze  forth  later.  (See  also  N.  B.  to 
Sec.  Ill,  of  Part  B.) 

"  Make  sure  it's  out," — where  there  is 
smoke  there  is  apt  to  be  fire.  If  the  fire 
has  burned  in  concealed  places  (between 
walls,  under  roofs  and  cornices,  or  in  inac- 
cessible places),  it  may  be  well  to  leave  a 
guard  until  it  is  certain  that  the  fire  is  com- 
pletely out.  All  fires  should  be  immediately 
followed  by  a  careful  investigation  to  as- 
certain the  extent  of  possible  damage  to 
electric  wiring,  chimneys,  flues,  etc. — con- 
ditions which  themselves  may  be  very 
dangerous. 


PART  C  —  FIRE  APPLIANCES  AND 
SAFEGUARDS 

N.  B—  Consult  also  the  U.  Lab.  list  of  ap- 
proved "  Fire  Appliances,"  which  contains  a 
list  of  manufacturers.  The  list  also  gives 
brief  descriptions  of  the  standard  articles. 

I 

CHEMICAL  EXTINGUISHERS 

i.  Chemical  Extinguishers  on  Wheels, 
33  Gallons. — "  These  appliances  are  effective 
on  fires  where  water  or  solutions  containing 
large  percentages  of  water  are  effective. 
Their  use  on  electric  arcs  or  wiring  carrying 
high  voltages  may  be  dangerous  on  account 
of  the  conductivity  of  the  liquid.  They  are 

33 


34  HOSPITAL  FIRE  MANUAL 

of  limited  service  in  hazardous  fluid  fires. 
They  must  be  protected  from  freezing." 
(U.  Lab.) 

These  extinguishers  are  valuable  for  hos- 
pitals not  readily  accessible  to  a  municipal 
fire  department,  for  the  fighting  of  fires 
beyond  the  incipient  stage. 

2.  Chemical  Hand  Extinguishers. — (a) 
The  standard  size,  2.5  gallons,  is  useful  on 
incipient  fires  within  the  limitations  de- 
scribed above  for  wheel  extinguishers.  It 
is  highly  efficient  but  heavy  and  difficult 
for  women  and  children  to  handle. 

(b)  The  small  size,  1.5  gallons,  is  preferable 
in  most  instances,  as  it  is  "  intended  pri- 
marily for  use  by  women  and  children" 
(U.  Lab.). 

N.  B— The  chemicals  used  in  the  "wheel," 
"standard,"  and  "small  size"  extinguishers 
are  sodium  bicarbonate  and  sulphuric  acid. 


HOSPITAL  FIRE  MANUAL  35 

(c)  The  one-quart  size  hand  extinguisher 
utilizes  special  liquids,  the  chief  ingredient 
of  which  is  said  to  be  carbon  tetrachloride. 
These  hand  extinguishers  have  the  great 
advantages  of  being  so  small  that  they  can 
be  handled  by  women,  children,  and  am- 
bulant patients;  one  person  can  carry 
several  of  them  at  one  time;  they  are  effec- 
tive on  incipient  fires  in  hazardous  fluids, 
cotton,  and  fabrics,  rapidly  burning  mate- 
rials, and  in  fires  not  easily  extinguished  by 
water  (as  volatile  liquids  and  oils);  they 
can  be  used  on  electric  arcs  or  wiring  carry- 
ing high  voltages  without  danger  to  the 
users;  will  not  freeze;  and  the  liquids  used 
will  not  usually  damage  fabrics  and  other 
ordinary  articles.  They  are  especially  ser- 
viceable for  garage  and  automobile  use,  and 
about  electric  machinery  and  arcs.  "  They 
are  not  recommended  for  service  on  fires  in 


36  HOSPITAL  FIRE   MANUAL 

freely  burning  material  (such  as  wood)  of 
any  considerable  quantity."     (U.   Lab.) 

N.  B. — Chemical  hand  extinguishers 
should  be  readily  available  on  each  floor 
of  a  building,  including  cellar  and  attic,  in 
very  accessible  places,  preferably  in  hall- 
ways and  near  red  lights.  They  should  be 
inspected,  tested,  and  refilled  as  often  as 
necessary,  and  bear  tags  giving  dates  of 
refilling  in  ink,  typewriting,  or  stamped. 
See  the  U.  Lab.  list  for  manufacturers  of 
approved  types  of  extinguishers. 


II 

OTHER  HAND  EXTINGUISHERS 

i.  Pail  Type. — Made  in  8,  10,  12,  and  14- 
quart  sizes.  Pails  of  water  are  the  best 
and  cheapest  fire  extinguishers  known  for 
most  of  the  ordinary  beginning  house  fires. 
Everybody  understands  their  use  and  al- 
most anybody  can  use  them.  Their  use  is, 
of  course,  limited  to  fires  in  which  water  is 
effective,  and  which  can  be  easily  reached 
by  water  thrown  from  a  pail.  They  are  of 
little  use  on  oils  and  inflammable  liquids, 
and  are  dangerous  on  electrical  arcs  and 
machinery,  and  on  high-voltage  wires.  In 
such  places  pails  filled  two-thirds  full  of 
clean,  dry  sand,  containing  scoops  for  throw- 
ing it,  are  useful  accessory  means  of  protec- 
tion. More  valuable,  however,  for  this 

37 


38  HOSPITAL  FIRE  MANUAL 

purpose,  are  the  one-quart  size  hand  ex- 
tinguishers mentioned  above. 

The  smaller  pails  are  preferable  for  hos- 
pitals, as  they  can  be  more  easily  used  by 
women,  children,  and  patients.  They  should 
be  made  of  iron,  steel,  or  fibre;  have  rounded 
bottoms  so  they  cannot  easily  be  used  for 
other  purposes  or  misplaced;  should  be 
painted  red  and  marked  with  the  words 
"Fire"  or  "For  Fire  Only"  in  black  letters, 
2^  or  more  inches  high;  should  be  suspended 
from  brackets  or  placed  on  shelves  containing 
pail-holes,  and  never  on  window-sills,  work- 
tables,  stock-shelves,  or  other  places  not  in- 
tended for  them;  the  tops  of  the  pails  should 
not  be  over  5  feet  above  the  floor  and  the 
bottoms  not  less  than  2  feet  above  it;  they 
should  be  refilled  once  weekly  with  clean 
water,  and  one  person  held  responsible  for 
their  care;  when  exposed  to  low  tempera- 


HOSPITAL  FIRE  MANUAL  39 

tures  the  contents  should  be  protected 
against  freezing  by  the  addition  of  2  pounds 
of  common  salt,  or  preferably  2  pounds  of 
calcium  chloride,  to  each  pail,  with  thorough 
stirring  to  dissolve  (see  "  Freezing  Preven- 
tives for  Fire  Pails  "  and  "  Water  Barrels 
and  Pails,"  by  N.  F.  P.  A.).  As  a  general 
rule  there  should  be  two  or  more  pails  for 
each  1000  square  feet  or  fraction  thereof; 
this  will  necessarily  vary  where  the  floor 
area  is  not  continuous  but  divided  into 
room  space,  halls,  etc.;  the  various  small 
areas  may  not  be  so  accessible  as  one  large 
area,  and  may  therefore  require  more  pails 
in  proportion;  the  pails  should  be  located 
near  the  most  vulnerable  points,  hi  plain 
sight,  and  in  no  manner  covered  or  ob- 
structed. 

It  is  advisable  to  use  such  pails  only  as 
are  listed  by  the  U.  Lab. 


40  HOSPITAL  FIRE  MANUAL 

2.  Dry  Powder  Hand  Extinguishers. — 
These  are  the  least  reliable  and  most  in- 
efficient extinguishers  known.  Unfortu- 
nately they  are  also  very  widely  used,  and 
can  be  found  in  many  hospitals.  The  writer 
has  seen  one  hospital  which  contained  no 
other  equipment  except  stand  -  pipes  and 
hose.  The  extinguishers  could  not  be  opened 
by  jerking  or  pulling,  and  readily  sustained 
1 80  pounds  weight;  the  hose  attached  to 
the  stand-pipes  was  so  large  that  with  a 
full  stream  it  could  have  been  handled  only 
by  trained  firemen  or  strong  men.  The 
dry  powder  extinguisher  proved  to  be  worse 
than  useless  in  the  famous  Iroquois  Theatre 
fire. 

This  type  of  extinguisher  usually  contains 
bicarbonate  of  soda,  a  small  amount  of 
coloring-matter,  and  some  starch  or  clay  to 
prevent  caking. 


HOSPITAL  FIRE  MANUAL  41 

They  are  of  very  slight  value  in  a  certain 
class  of  fires  as  first-aid  accessories  where 
the  temperatures  are  very  low,  in  museums, 
libraries,  on  inflammable  liquids,  and  elec- 
trical machinery,  and  where  water  itself 
may  be  as  bad  as  fire.  Even  so,  they  still 
present  difficulties  in  opening  and  scattering 
the  contents,  owing  to  the  metal  caps  and 
tubular  shape.  Pails  of  sand  are  very  much 
better. 

Furthermore,  considering  their  extremely 
limited  utility,  general  inefficiency,  and 
cheap  construction  and  contents,  they  can- 
not be  regarded  as  inexpensive  when  sold 
for  several  dollars  apiece. 

(They  are  not  mentioned  in  the  U.  Lab. 
list  of  approved  fire  appliances.) 

3.  Grenade  Type. — This  type,  usually 
consisting  of  bottles  containing  fluids,  a 
large  percentage  of  which  is  water,  is  of 


42  HOSPITAL  FIRE  MANUAL 

so  little  value  as  to  be  practically  worthless. 
The  false  sense  of  security  which  may  result 
from  their  presence,  and  the  time  lost  in 
attempting  to  quench  a  fire  with  them, 
may  be  very  dangerous.  They  are  hardly 
equivalent  in  value  to  a  pitcherful  of  water. 
(They  are  not  mentioned  in  the  U.  Lab. 
list  of  approved  fire  appliances.) 


Ill 

OTHER  APPLIANCES 

1.  Fire  Doors  and  Shutters. — The  use  of 

these  in  corridors  connecting  adjacent  build- 
ings, or  to  close  openings  in  fire  walls,  or 
for  walls  which  are  partially  fire-proof, 
should  be  carefully  considered  and,  in  many 
instances,  is  very  advisable.  The  U.  Lab. 
have  listed  a  large  number  of  firms  which 
supply  approved  types  of  fire  doors,  shutters, 
etc. 

2.  Fire  Retardant  Paints. — These  are  val- 
uable, as  they  retard  the  spread  of   fire. 
There  are  many  places  in  hospitals  in  which 
they  can,  and  should  be  used.     Wherever 
possible   they   should   be   used   instead   of 
shellac,  varnish,  and  oil,  especially  as  the 
latter  are  more  inflammable  than  ordinary 

43 


44  HOSPITAL  FIRE  MANUAL 

paints.  Many  uncoated  wood  surfaces  could 
advisedly  be  covered  with  fire  retardant 
paint.  (See  the  U.  Lab.  list  of  manufactur- 
ers of  approved  paints.) 

3.  Fire  Hose  and  Faucets. —  Hose  should 
be  rubber  lined  or  unlined  linen,  made  in 
accordance  with  the  standard  specifications, 
and  passed  by  U.  Lab.  (See  their  list  of 
approved  appliances  for  names  of  manu- 
facturers.) 

It  should  be  of  sufficient  length  to  reach 
all  enclosed  places  and  not  less  than  2^2 
inches  diameter;  tested  at  stated  intervals, 
and  bear  a  tag  giving  dates  of  inspections 
and  tests;  and  always  be  connected  with 
stand-pipe,  ready  for  emergency  use. 

Faucets. — Some  or  all  of  the  ordinary 
water  taps  should  be  threaded  for  the  attach- 
ment of  garden  hose,  which  can  be  of  ser- 
vice as  supplementary  fire  equipment.  Such 


HOSPITAL  FIRE   MANUAL  45 

hose  can  be  handled  by  women  and  children, 
whereas  the  regular  fire  hose  (2^  inches  or 
more)  requires  one  or  more  strong  men  or 
trained  firemen. 

4.  Fire-escapes  and  Ladders. — Many  of 
the  numerous  types  of  fire-escapes  are  not 
suitable  for  hospitals  and  some  should  not 
even  be  considered.  Among  these  are  es- 
capes consisting  in  part,  or  entirely,  of 
vertical  ladders,  which  end  in  a  locked  door, 
or  any  part  of  which  is  not  protected  by 
railing,  or  is  not  of  sufficiently  substantial 
design  to  inspire  confidence.  Fire-escapes 
should  usually  extend  to  the  roof,  especially 
if  the  latter  contains  skylights  or  other  exit 
facilities.  If  improperly  located  or  con- 
structed they  may  be  both  dangerous  and 
useless.  Escapes  should  be  tested  from 
time  to  time,  and  repainted  sufficiently  often 
to  prevent  rusting.  They  should  be  kept 


46  HOSPITAL  FIRE  MANUAL 

clean  in  winter — if  covered  with  snow  or 
ice  they  may  be  useless  when  needed,  or 
cause  fatal  accidents. 

One  or  more  extension  ladders  may  be 
valuable  in  fighting  advancing  fires. 

5.  Fire-Alarm  Box. — Every  hospital  which 
is  reasonably  accessible  to  a  municipal  fire 
department  should  endeavor  to  have  a  fire- 
alarm  box  installed  to  signal  the  department- 
headquarters,  and  arrange  for  response  to 
hospital   alarms.     The   Rochester,   N.    Y., 
Fire  Department  has  gladly  extended  this 
assistance  to  "  lola,"  the  Monroe  County 
Tuberculosis  Hospital,  situated  a  short  dis- 
tance   beyond    the    Rochester    City    Line. 
(See  also  page  61.) 

6.  Sprinkler  Systems. — These  are,  briefly, 
appliances  for  the  spraying  of  water  over 
the  area  of  an  incipient  fire.     The  heat  of 
the  fire  to  be  extinguished  automatically 


HOSPITAL  FIRE   MANUAL  47 

frees  the  water  by  acting  upon  the  valves 
or  "  heads"  of  the  sprinkler  system.  They 
usually  give  adequate  protection  if  properly 
installed,  and  carefully  supervised  and 
maintained. 

The  sprinkler  appliance  may  be  of  value 
in  large  hospital  buildings  whether  they  are 
fire-resisting  or  not,  if  they  contain  large 
untenanted  portions,  and  especially  if  such 
portions  contain  much  inflammable  material. 
Each  hospital,  however,  may  present  a 
separate  problem,  and  the  question  must 
be  studied  with  regard  to  the  fire  problem 
as  a  whole. 

A  hospital  planning  to  install  a  sprinkler 
system  should  act  only  upon  the  advice  of 
a  competent  fire-prevention  engineer.  It  is 
further  advisable  for  the  sprinkler  system, 
if  adopted,  to  be  installed  in  accordance  with 
the  rules  and  regulations  of  the  N.  F.  P.  A. 


48  HOSPITAL  FIRE   MANUAL 

The  successful  operation  of  a  sprinkler 
system  necessarily  depends  upon  adequate 
water-supply  and  -pressure  and  immediate 
automatic  opening  of  the  sprinkler-heads. 
The  system  should  be  inspected  at  definite 
intervals,  usually  not  less  often  than  once 
monthly,  so  that  deterioration,  obstruction, 
etc.,  may  be  prevented.  For  instance, 

1.  Dust  and  dirt  should  not  be  allowed 
to  accumulate  on  the  heads. 

2.  The    heads    should    not    be    painted, 
nor  covered  with  oils,  polish,  whitewash, 
wax  or  other  coatings,  except  when  first  in- 
stalled,, and  then  only  with  an  anti-corrosive 
coating  recommended  by  a  reliable  expert. 

3.  Shelves,  stored  material,  etc.,  should 
not  be  permitted  even  temporarily  to  ob- 
struct the  heads. 

4.  Heads   which    appear    to   be   injured 
should   be    promptly   replaced.     If   several 


HOSPITAL  FERE   MANUAL  49 

appear    spoiled,  that   part    of    the    system 
should  be  tested. 

5.  Extra  sprinkler-heads  should  always  be 
on  hand,  ready  for  use.     Various  employees 
should   be   informed  as   to   their  place  of 
storage. 

6.  After  a  fire  the  open  heads  should  be 
immediately    replaced    and    valves    opened 
promptly. 

7.  Valves  should  always  be  open,  except 
when  temporarily  closed  for  repairs,  etc. 

8.  Check  up,  with  a  list  on  file,  all  sprink- 
ler gate-valves,  noting  those  which  are  not 
open  and  strapped,  reasons  therefor,  etc. 

9.  Repairs,    when   necessary,    should   be 
made  immediately,  and  only  by  a  mechanic 
who  thoroughly  understands  such  work. 

10.  Pressure  gauge  should  be  noted  and 
report  made  to  Superintendent  and  Chief 
Engineer  if  too  low. 


50  HOSPITAL  FIRE  MANUAL 

11.  Attention  should  be  given  to  all  con- 
ditions mentioned  in  Part  "  D  "  on  water 
supply. 

12.  These  duties  should  usually  be  made 
a  part  of  the  regular  required  duties  of  one 
or  more  regular  employees,  and  not  second- 
ary to  other  tasks. 


PART  D— MISCELLANEOUS 
PRECAUTIONS 

1.  Water-Supply. — The  adequacy  of  the 
water-supply  and    water-pressure    for  fire 
fighting    should    be    determined.     This    is 
especially  important  in  large  buildings.     It 
is  advisable,  preferably  in  the  Spring  and 
Autumn,  when  the  hydrants  are  flushed,  to 
place  the  entire  system  under  pressure  to 
ascertain  the  soundness  of  the  piping,  valves, 
hose,  etc. 

2.  Valves. — All  valves,  especially  in  base- 
ments, engine-rooms,  closets,  or  concealed 
places,  which  may  be  used  to  shut  off  water- 
supply  from  buildings  or  sections  of  build- 
ings, should  be  painted  a  bright  red,  and 
have  securely  attached  to  them  (with  wire) 
tags  stating  in  typewriting  or  ink  the  exact 

51 


52  HOSPITAL  FIRE   MANUAL 

building  or  part  of  same  which  they  control. 
This  is  especially  important  if  they  control 
a  separate  water-supply  to  stand-pipes  or 
risers, — such  valves  and  others,  closed  only 
when  making  repairs,  should  be  locked 
open  to  prevent  tampering  with  them. 

Valves  which  must  be  kept  closed  should 
be  tested  weekly  by  giving  them  a  quarter 
turn.  They  should  not  be  closed  too  tightly. 
The  writer  has  visited  hospitals  in  which 
important  valves  could  be  opened  only  with 
great  difficulty. 

3.  Hydrants  should  be  opened  and  flushed 
thoroughly  in  the  Spring  and  Autumn,  tested 
from  time  to  time,  always  kept  free  from 
obstructions,  and  protected  against  freezing 
during  the  winter. 

4.  Gravity  and  Pressure  -  Tanks  should 
be  carefully  inspected  from  time  to  time. 
Hoops,    telltales,   and    glass -gauge    valves 


HOSPITAL  FIRE  MANUAL  53 

should  be  kept  in  good  condition.  Air-pres- 
sure and  water-level  should  always  be  prop- 
erly maintained.  During  the  Winter  care 
should  be  taken  to  prevent  the  formation 
of  ice  in  gravity-tanks.  Pressure-gauges 
should  be  inspected  frequently. 

5.  Locked  Doors. — Any  door  which  is 
kept  locked  all  or  part  of  the  time,  which 
may  be  needed  as  an  emergency-exit,  should 
have  placed  near  or  upon  it  a  fire  axe,  or 
the  door-key  in  a  glass-faced  box,  or  should 
be  locked  with  padlock  having  brittle  shackle, 
or  should  be  equipped  with  all  of  these,  de- 
pending upon  the  circumstances.  The  pad- 
lock with  brittle  shackle  is  an  excellent 
means  of  locking  doors,  hose-boxes,  etc., 
where  an  appearance  of  security  is  desired 
without  preventing  easy  access.  (Refer  to 
the  U.  Lab.  list  of  manufacturers  of  ap- 
proved appliances.)  It  must  not  be  for- 


54  HOSPITAL  FIRE  MANUAL 

gotten  that  the  door  which  can  be  readily 
broken  open  by  a  kick  or  body  pressure 
exists  chiefly  in  drama  and  fiction;  even 
ordinary  doors  cannot  be  opened  easily  in 
this  way,  and  many  will  resist  the  combined 
efforts  of  several  strong  men.  Such  locked 
doors  have  caused  the  loss  of  many  lives. 


PART  E— HOSPITAL  FIRE 
DEPARTMENT 

Although  in  many  hospitals  only  the  in- 
cipient fire  can  be  controlled,  it  is  neverthe- 
less necessary  to  have  an  adequate  organiza- 
tion, drill,  and  equipment  in  order  to  retard 
an  extending  fire,  and  thus  afford  tune  for 
the  safe  removal  of  all  occupants  and  valu- 
able contents.  Practically  every  hospital 
should  have  a  private  fire  department 
planned  along  the  lines  described  below. 

i.  Rules. — These  should  be  as  few  as 
possible,  and  clearly  and  concisely  worded. 
The  general  rules  must  also  meet  the  peculiar 
needs  of  each  hospital.  They  will  usually 
forbid  the  use  or  possession,  or  both,  of 
matches,  candles,  tobacco,  lamps,  alcohol, 
heating  devices,  the  accumulation  of  waste, 

55 


56  HOSPITAL  FIRE    MANUAL 

papers,  etc.,  except  by  written  permission  of 
the  superintendent;  they  will  forbid  tam- 
pering with  fire  appliances,  and  will  direct 
what  to  do  if  fire  is  discovered — as  reporting 
to  nurse  in  charge  of  floor  or  building,  or  to 
superintendent,  etc.  (such  person  being  in 
each  instance  the  nearest  officer  in  author- 
ity). Special  rules  will  be  required  to  safe- 
guard certain  hazards,  as  in  barns,  garage, 
storerooms,  attic,  kitchen,  laundry,  etc. 
The  storing  of  automobiles,  motor-cycles, 
and  hazardous  fluids  except  in  places  desig- 
nated should  be  forbidden.  The  rules  pre- 
scribing the  duties  of  each  employee  (see 
also  pages  60  and  65)  will  include  a  clear 
definition  of  their  responsibilities  in  the 
event  of  fire,  and  from  time  to  time  separate 
instructions  may  be  given  to  selected  pa- 
tients. The  plan  of  fire  organization  should 
be  included  in  the  rules,  or  posted  separ- 


HOSPITAL  FIRE  MANUAL  57 

ately;  if  a  location  alarm  is  established  the 
location  signals  should  be  conspicuously 
posted.  It  is  usually  best  to  post  the  general 
fire  rules  in  conspicuous  places,  possibly  to 
print  them  in  red,  on  a  buff-colored  card- 
board or  paper,  and  plainly  headed  "  FIRE 
RULES."  The  penalty  for  their  infraction 
should  be  stated  and  usually  strictly  en- 
forced. 

2.  Organization. — The  type  of  hospital 
buildings,  classes  of  patients  treated,  num- 
ber of  employees  of  each  sex,  etc.,  must 
govern  the  manner  of  organization.  The 
objects  to  be  accomplished  may  be  mapped 
out  in  their  order  of  importance,  the  most 
difficult  first.  For  instance,  lives  are  more 
important  than  property,  the  children  and 
bed  patients  will  require  more  assistance 
than  ambulant  patients  and  employees,  and 
the  office  contents  are  more  important  than 


58  HOSPITAL  FIRE  MANUAL 

patients'  personal  effects.  Usually  the  fire 
is  discovered  in  its  incipiency  when  only 
few  fire-fighters  are  needed,  but  a  number 
of  attendants  may  be  needed  immediately 
to  remove  the  children  and  bed  patients. 
In  this  there  must  be  no  delay,  as  incipient 
fires  often  spread  and  destroy  lives  and  prop- 
erty with  unbelievable  rapidity.  Therefore 
some  form  of  organization  on  the  following 
lines  is  necessary 

Inspector Chief Messengers. 


Asst. 


Chief. 


Floor     Captains. 


Rescue  Company       Fire  Company  Salvage  Company 

Stretcher  men  Extinguisher  men  Any  persons  avail- 
Exit  guards  Pail  men  able  after  rescue 
Stair  guards  Hose  men  work  is  finished. 
Hall  guards  Ladder  men 

Engineer 

Asst.  to  engineer 


HOSPITAL  FERE  MANUAL  59 

The  chief  should  be  the  chief  resident 
officer,  the  assistant  chief  the  next  in  au- 
thority; and  the  floor  or  pavilion  captains 
should  be  the  nurses  in  charge.  The  in- 
spector may  be  the  night-watchman,  and 
the  messengers  will  be  any  patients  or  boys 
who  may  not  be  strong  enough  or  suffi- 
ciently skilled  to  assist  with  rescue  work 
or  fire  fighting.  The  rescue  company  should 
consist  of  a  sufficient  number  of  able-bodied 
men  or  women  to  remove  the  children  and 
bed  patients.  Guards  may  be  needed  to 
prevent  crowding  and  accidents  in  hall- 
ways, fire-escapes,  and  doors.  The  engineer 
should  usually  have  no  other  duties  than  to 
attend  to  the  engine-room.  Usually  also 
he  will  need  one  assistant  or  fireman,  espe- 
cially if  one  or  more  fire-pumps  are  in  use. 
The  extinguisher,  pail,  and  hose  men  will 
preferably  be  employees,  who  can  be  trained 


60  HOSPITAL  FIRE  MANUAL 

to  handle  the  fire  appliances  with  rapidity 
and  effectiveness.  The  salvage  company 
will  include  any  able-bodied  and  available 
persons  not  required  for  fire  apparatus  or 
rescue  work,  to  save  such  property  as  can 
be  readily  removed  from  the  buildings. 
The  hose  men  should  be  strong,  as  a  fire 
hose  stream  cannot  be  easily  handled  by 
any  others — at  least  two  men  are  usually 
necessary. 

3.  The  Fire  Drill.— The  object  of  the  drill 
is  twofold,  viz.:  (i)  to  train  the  employees 
and  others  to  effectively  man  the  fire  ap- 
paratus, and  (2)  to  prevent  panic  by  teach- 
ing patients  and  employees  self-control  and 
by  training  them  in  orderly  and  rapid 
methods  of  exit. 

The  signal  apparatus  may  consist  of  a 
fire-whistle  or  electric  bells  or  gongs  (see 
N.  B.  F.  U.  approved  list).  An  alarm 


HOSPITAL  FIRE  MANUAL  61 

should  be  selected  which  is  loud,  but  of  soft 
tone  to  prevent  unnecessary  excitement. 
Two  signals  should  be  arranged  for — one 
for  drill  and  one  for  real  fire.  The  fire-signal 
may  be  so  given  that  the  actual  location  of 
the  fire  is  also  indicated  by  a  succession 
of  gong-strikes,  bell-rings,  or  whistles. 

Immediately  upon  the  drill  signal  being 
given  all  persons  shall  report  to  the  sta- 
tions assigned  to  them,  and  immediately 
prepare  to  perform  the  duties  required  of 
them  by  the  rules.  The  stretcher  men  and 
guards  will  report  to  rooms  or  wards  con- 
taming  bed  patients  and  children,  to  remove 
them  under  the  direction  of  the  nurse  in 
charge,  who  acts  as  floor  captain.  After 
all  have  been  presumably  removed  these 
men  shall  report  to  the  floor  captain  for 
further  duty.  The  extinguisher  men  and 
pail  men  will  immediately  report  at  the  site 


62  HOSPITAL  FIRE  MANUAL 

of  the  fire,  bringing  the  appliances  in  their 
charge.  The  hose  men  will  man  the  hose 
at  the  site  of  the  fire.  These  will  work 
under  the  personal  direction  of  the  chief 
or  his  assistant.  The  engineer  must  start 
the  fire-pump  immediately  upon  hearing 
the  drill  alarm,  raise  the  water-pressure, 
stoke  fires,  etc.,  without  awaiting  further 
orders.  The  salvage  company  will  take 
orders  from  the  chief  or  his  assistant,  and 
their  work  may  be  organized  on  the  ground 
after  the  alarm  is  given.  In  small  hospitals 
this  company  may  be  incorporated  with  the 
fire  company.  The  inspector  and  the  mes- 
senger will  perform  such  duties  as  may  be 
assigned  them,  the  latter  being  prepared  to 
render  personal  service  to  the  chief,  carry 
messages,  etc.  The  inspector  may  be  used 
to  attend  to  the  hose  lines,  signal  to  others, 
etc.  As  a  general  rule  the  chief  and  his 


HOSPITAL  FIRE  MANUAL  63 

assistant  should  alternately  direct  the  fire 
and  the  rescue  companies,  so  that  they  will 
become  equally  proficient  in  the  work  of 
supervision. 

The  ladder  and  hose  men  should  become 
proficient  in  the  use  of  their  apparatus— 
especially  the  latter  should  become  accus- 
tomed to  the  "  recoil  "  and  "  weight  "  of  the 
hose.  This  is  exceedingly  important,  es- 
pecially where  a  high-pressure  stream  is 
used,  as  it  is  not  only  difficult  to  manage, 
but  may  cause  fatal  injuries  to  those  whom 
it  might  strike. 

Hose  practice  should  include  the  connect- 
ing of  hose  to  hydrants,  leading  it  into 
buildings,  and  directing  full  stream  upon 
roofs,  etc.  General  drill  for  efficiency  and 
speed  in  handling  does  not  require  water 
being  turned  on.  Special  care  must  be 
taken  to  prevent  kinks  and  twists  in  hose; 


64  HOSPITAL  FIRE  MANUAL 

these  must  be  removed  before  water  is 
turned  on,  otherwise  hose  may  burst;  burst- 
ing may  also  occur  if  hose  is  twisted  or 
kinked  after  water  is  on.  Hose  containing 
short  bends  near  nozzle  is  difficult  to  hold, 
and  may  recoil — only  easy  curves  should  be 
permitted. 

Drill  should  be  held  at  regular  intervals, 
preferably  once  monthly,  and  without  no- 
tice, with  an  occasional  night  drill.  The 
hospital  managers  should  personally  review 
some  or  all  of  the  drills.  A  record  should 
be  kept  of  the  time  required  for  drills,  and 
special  work  done,  as  connecting  of  hose  to 
hydrants,  time  for  bringing  apparatus,  etc., 
and  all  concerned  encouraged  to  maintain 
records,  within  such  limitations  as  provide 
for  their  personal  safety.  The  entire  drill 
should  be  developed  to  a  degree  of  military 
precision  and  discipline. 


HOSPITAL  FIRE  MANUAL  65 

4.  Inspection  Service. — The  work  of  in- 
spection should  be  usually  divided  between 
the  engineer  and  the  night  watchman,  with 
a  general  inspection  from  tune  to  time, 
especially  during  the  Winter,  by  the  super- 
intendent and  the  managers.  The  engineer's 
rules  should  require  that  he  make  a  daily 
inspection  of  the  buildings,  noting  the  con- 
dition of  the  valves,  pipes,  tanks,  gauges, 
telltales,  stand-pipes  (obstructions,  etc.), 
escapes,  emergency  pumps,  water  supplies, 
etc.  In  the  instance  of  water-intakes  lo- 
cated at  lakes,  ponds,  brooks,  or  enclosed 
springs  at  some  distance,  the  inspection, 
providing  the  service  is  usually  satisfactory, 
need  be  made  but  once  or  twice  monthly. 

The  night-watchman's  rules  should  require 
that  he  note  the  condition  and  location  of 
the  fire  appliances  and  safeguards,  and  daily 
report  any  defects,  losses,  or  misplace- 


66  HOSPITAL  FIRE  MANUAL 

ments,  apparent  violations  of  the  fire  rules, 
special  hazards  observed,  or  other  observa- 
tions he  may  make  concerning  fire  matters. 
He  should  be  provided  with  an  approved 
watchman's  clock  (see  U.  Lab.  list)  and  the 
stations  so  placed  that  his  rounds  will  in- 
clude the  locations  of  fire  appliances  and 
of  possible  hazards  (kitchens,  engine,  and 
dynamos,  furnace  rooms,  etc.).  He  should 
have  definite  instructions  as  to  his  duties 
in  any  emergency. 

5.  Miscellaneous  Considerations. —  (a) 
Hospital  Fire  Association. — The  plan  of  a 
private  fire  association  as  worked  out  by 
several  corporations  is  worthy  of  adoption 
by  the  larger  hospitals,  as  it  has  considerable 
merit.  The  scheme  includes  a  regular  or- 
ganization of  all  who  are  concerned  in  the 
hospital  fire  department,  having  a  constitu- 
tion, by-laws,  regular  meetings,  etc.  Mem- 


HOSPITAL  FIRE  MANUAL  67 

bership  can  be  made  a  matter  of  merit, 
educational  work  can  be  done  among  the 
patients  and  employees,  and  the  hospital 
morale  improved  to  no  small  degree.  Its 
work  may  be  developed  to  include  "  Fire 
Day,"  with  lectures,  moving  pictures,  con- 
tests, etc. 

(b)  Cooperation. —  Neighbors  residing  with- 
in hearing  distance  of  the  fire  signal  may 
be  invited  to  respond  to  it.  Such  co- 
operation may  be  mutually  valuable  and 
advantageous. 

Where  arrangement  has  been  made  with 
a  local  municipal  fire  department  to  respond 
to  calls,  it  should  be  given  supreme  charge 
immediately  upon  its  arrival.  However,  no 
time  should  be  lost  awaiting  such  assistance, 
as  even  in  cities  the  average  time  for  a 
good  fire  department  to  arrive  is  several 
minutes,  and  minutes  are  hours  for  fire. 


68  HOSPITAL  FIRE   MANUAL 

Furthermore,  in  rural  buildings  fires  are 
seldom  controlled  after  spreading  beyond 
the  incipient  stage.  (See  also  page  46.) 

N.B. — In  recent  years,  owing  to  the  in- 
creased magnitude  of  the  American  Fire 
Problem,  the  study  and  practice  of  fire  pre- 
vention and  protection  have  become  a  dis- 
tinct engineering  specialty.  Extensive  lit- 
erature has  grown  up  about  the  subject,  and 
treatises  can  be  found  on  almost  any  of  its 
phases.  Those  who  wish  to  become  better 
informed  than  is  possible  from  this  brief 
manual  may  find  the  following  works  useful: 

"  Field  Practice,"  by  N.  F.  P.  A. 

"  Fire  Prevention  and  Fire  Protection," 
by  J.  K.  Freitag  (J.  Wiley  &  Sons,  New 
York  City). 

"A  Cyclopedia  of  Fire  Prevention  and 
Insurance,"  which  includes  chapters  by 
many  fire  specialists. 


HOSPITAL  FIRE  MANUAL  69 

"The  Prevention  of  Fire  in  Old  Build- 
ings Housing  the  Insane/5  by  J.  Allen  Jack- 
son, N.  Y.  Medical  Journal,  March  25, 1916. 

Reports  on  tests  of  materials,  building 
construction,  etc.,  by  the  United  States 
Geological  Survey. 

"  Standard  Rules  and  Requirements  for 
Safeguarding  Hazards,"  by  N.  F.  P.  A. 

"  State  Laws  and  Municipal  Ordinances 
for  Regulating  Fire  Hazards,"  by  N.  F.  P.  A. 

"  Standard  Rules  and  Requirements  for 
Fire  Protection,"  by  N.  F.  P.  A. 

Educational  pamphlets  by  N.  F.  P.  A. 


5 


1  5J? 


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